Michigan Department of Social Services, Interagency Coordination Program, Joellen Edwards Also, describe, to the extent possible, the provision of drugs and biologicals, supplies, appliances and equipment. The National Association of Health Data Organizations has also opposed such an inclusion. Other data items are related to a specific episode of care and will be provided at each encounter. Much of the required information can be located on the patient's face sheet. OMB is currently investigating the possibility of changes to this classification, and the Committee will await the OMB recommendations. Bureau of Health Professions, HRSA, Fernando M. Trevino, Ph.D., M.P.H. Patient's Relationship to Subscriber/Person Eligible for Entitlement, 12. Current or Most Recent Occupation and Industry - This data item is very useful to track occupational diseases as well as to better define socioeconomic status. Health Care Financing Administration, Steven M. Melov National Academy for State Health Policy, Marie Roberto, Dr.P.H. However, a place holder for this element is recommended to the standards-setting organizations. Although it is best understood in conjunction with a socioeconomic indicator, researchers may gain a better understanding of the trends and impact of care on racial/ethnic minorities in the U.S. The Committee recognizes that this is an iterative process and has included in these recommendations several elements that have been proposed for standardization, even though no consensus currently exists concerning appropriate or feasible definitions. They do represent those items that are routinely collected in many efforts, such as basic person information, as well as items specific to inpatient or ambulatory care settings, such as provider information, diagnoses, and services. Initial enumeration by HCFA will focus on individual providers covered by Medicare and Medicaid; however, the system will enable enumeration of other health care practitioners, as identified by system users. ), particularly when used alone, and impediments (legal and otherwise) to its use. Date of Birth - Year, month and day - As recommended by the UHDDS and the Uniform Ambulatory Care Data Set (UACDS). Molly A. Anthony, Ph.D. External Cause of Injury - This item should be completed whenever there is a diagnosis of an injury, poisoning, or adverse effect. HHS, NID, Division of Epikdemiology and Prevention Research, William J. Sobaski, M.B.A. Patient's Expected Sources of Payment - The following categories are recommended for primary and secondary sources of payment: 40A. Medical and Health Research Association, Gregg A. Pane, M.D. Place holders will be set, and, in some cases data items and definitions decided on, before national and local public health agencies and organizations will be able to act. 8. Type of Facility/Place of Encounter 1/, 19. Standardized data sets can serve many purposes in the current and future health care arena. Conditions should be coded that affect patient care in terms of requiring clinical evaluation; therapeutic treatment; diagnostic procedures; extended length of hospital or nursing home stay; or increased nursing care and/or monitoring. Office of the Assistant Secretary for Planning and Evaluation. These data items include birth name, date of birth, place of birth, gender, and mother's first name. University System of West Virginia, Curtis O. Porter These elements are unique to the UACDS. A data element is defined by size (in characters) and type (alphanumeric,. The MEDSTAT Group, Joel Diringer, JD. National Indian Council on Aging, Inc. Jacqueline R. Bennett National Institute on Drug Abuse, Cille Kennedy UHDDS Today Hospital or facility identification number or code. Functional Status - The functional status of a person is an increasingly important health measure that has been shown to be strongly related to medical care utilization rates. Most organizations were supportive in wanting to 'get on board' with standardized data elements. National Committee for Quality Assurance, James S. Todd, M.D. The National Committee on Vital and Health Statistics (NCVHS) and the Department of Health and Human Services, which it advises, have initiated and completed the first iteration of a process to identify a set of core health data elements on persons and encounters or events that can serve multiple purposes and would benefit from standardization. Massachusetts Health Data Consortium, Inc. Nancy Stout, Ed.D. The NCVHS recommended this as an optional item in the UACDS but that high priority should be given to conducting additional study as to the feasibility, ease and practical utility of collecting the patient's reason for encounter, in as close to the patient's words as possible. Additionally, too frequent modification of items or definitions will cause confusion, overlapping data definitions in a single data year, and add to the burden of the facility or organization. In August 1994, the Department asked the Committee to provide information and advice that will help maximize the utility of core person and encounter data for meeting the Department's responsibilities. Operating Clinician Identification (inpatient) 1/, 23. These same data bases are being used to provide input to Federal surveys such as the National Hospital Discharge Survey (NCHS) and the Hospital Cost and Utilization Project (AHCPR). Information is collected by a wide range of users and in a myriad of different formats. This item attempts to define what actually motivated the patient to seek care and has utility for analyzing the demand for health care services, evaluating quality of care and performing risk adjustment. Gender - Male, Female. Consensus has been reached on definitions for some of these elements; for others, there is much agreement, but definitions must still be finalized; and for a third group, additional study and testing are needed. Centers for Disease Control and Prevention, Lynn E. Jensen, Ph.D. 9. The Committee recognizes the ongoing discussion of discrepancies between 'expected' and 'actual' sources of payment. For those data elements which have been recognized as significant core elements, but for which there is not consensus on definition, support the formation of a public-private working group to conduct or coordinate additional study or research and to further refine definitions. Diagnosis Chiefly Responsible for Services Provided (outpatient) - The diagnosis, condition, problem, or the reason for encounter/visit chiefly responsible for the services provided. National Center for Health Statistics, Richard Rubin 40. Currently there is little or no input from the public health field for several reasons. National Institute of Health, Carl E. Hendricks, Lieutenant Col., MS The Alan Guttmacher Institute, Kathleen A. Frawley With the exception of the personal/unique identifier, they do not need to be collected at each encounter. Future projects may undertake to seek consensus among some of these items. There is not one agreed-upon coding system for this item; the International Classification of Primary Care, and the Reason For Visit Classification used by the National Ambulatory Medical Care Survey are two such systems. Sex, age, and race of the patient. Operating Clinician Identification - The unique national identification number assigned to the clinician who performed the principal procedure, as recommended by the UHDDS. White, M.P.H., Ph.D. Several states, including California, Oklahoma, and New York presented findings on using a combination of key data items to perform probabilistic matches. At a minimum, the following classification is suggested: The critical distinction here is whether followup is planned or scheduled, as an indicator of continuing health problems and continuity of care. The Committee's efforts, first in the area of inpatient hospital data (the Uniform Hospital Discharge Data Set or UHDDS) and later in the area of ambulatory care (the Uniform Ambulatory Care Data Set or UACDS) have moved the country in the direction of achieving comparability in the health data collected by federal agencies, states, localities and the private sector, as well as in the international community. University of California, San Francisco, Jaclyn Packer Review state-of-the-art of widely-used core data sets in the United States and other countries (including coding and formatting features that allow for flexibility); Obtain input, through hearings and other means, from the diverse parties who will report and use standardized data sets; Interact closely with recognized standards-setting groups; and. Each item that is recommended must be considered carefully. Participants in the various meetings had discussed ways to disseminate new data items, seek input, and inform data collectors of recommended elements and definitions. This has resulted in inconsistent data found in many outpatient databases and has skewed patient outcome studies. Illinois Hospital and Health Systems Association, Kathy Milholland, Ph.D., R.N. HBO and Company. The Committee recommends that the HCFA identifier be adopted when completed. However, in the three remaining areas of health plans/insurers, government, and data standards organizations, the vast majority supplied data sets. The currently recommended coding instrument is the ICD-9-CM. In addition, the historical knowledge of the NCVHS and its earlier decisions in the area of data standardization played a role in the preparation of a listing of core data elements and, where possible, recommended definitions. Such a system would be helpful to the extent that it is feasible in the current highly dynamic market. Other Diagnoses (outpatient) - The additional code(s) that describes any coexisting conditions (chronic conditions or all documented conditions that coexist at the time of the encounter/visit, and require or affect patient management). The goal has been to develop a set of data elements with agreed-upon standardized definitions that, when needed in a data collection effort, can be used to collect and produce standardized data. The latter element, which describes all conditions requiring evaluation and/or treatment or management at the time of the encounter as designated by the health care practitioner, has been divided into two elements: 1) the diagnosis chiefly responsible for services provided, and 2) other diagnoses. Which of the following data elements is unique to UACDS? Managed Behavioral Health News, Melvin Sabshin, M.D. The Committee works closely with the National Center for Health Statistics, the Agency for Health Care Policy and Research, and the Health Care Financing Administration (HCFA). Thus to meet the needs for standardized data, movement must be made toward standardized definitions for those data sets that are already in use, and for an increased use of standardized data elements and definitions by those data collection efforts for which no current standardized data sets exist. This element refers to living arrangements only. For those elements that the Committee recommends as being ready to standardize, request each of the data collection entities within the Department to review the set of data elements and to match data contents and definitions with similar items that they are currently collecting or plan to collect. In addition, there are some disabilities, such as severe mental illness or blindness, where ADLs and IADLs are not sufficient measures. One problem that was encountered was that of requesting what the private organizations consider proprietary information. Another problem is that, although the HHS Data Council has recently established a Health Data Standards Committee, until the past few months, there has been no central location within the Department for monitoring the activities of the data standards groups. James Cooney, Ph.D., former member, NCVHS, described the burden to organizations from the addition of a single data item. What clinical information is collected in the Uhdds? NCQA (National Committee for Quality Assurance). Significant medical procedures performed. National Center for Health Statistics. American Physical Therapy Association, Anthony J. In recent years, the focus of health care has been shifting to hospital outpatient and other outpatient care, including clinic, hospice and home care, sites for which standardized data collection had not been developed. The MDS system collects data on the physical, psychological, and psychosocial functioning of all residents of long-term facilities certified by Medicare or Center for Health Policy Studies, Rachael Block Additionally, a consensus must be reached on the unique personal identifier. Randall Spoeri, Ph.D. The priorities for recording an External Cause-of-Injury code (E-code) are: The collection of this element has been recommended by the UHDDS and the UACDS, and a separate element for its collection is included on the UB 92. Particular scales are more appropriate for measuring different functions or disabilities and should be selected on the basis of the needs of the patient population (such as, use of social functioning scales for those with mental disorders and substance abuse). It will do so by assigning a unique identifier to each provider. American Medical Association, Mark Epstein, Sc.D. However, identifiers are commonly removed when a data set is provided outside of a facility, such as to a state health data organization. Discharge Date (inpatient) - Year, month, and day of discharge as currently recommended in the UHDDS and by ANSI ASC X12. Health Care Financing Administration, Emily Friedman However, the information is still considered useful to collect for trend purposes and for some indication of patients' coverage by third-party payers. Their continuing study is involved with more detailed data elements that relate specifically to the areas of mental heath, substance abuse, and long term care. National Center for Health Statistics, David P. Winchester, M.D. Michigan Department of Social Services, Interagency Coordination Program, Stephen W. Wyatt, D.M.D., M.P.H. Together with marital status, this element provides a picture of potential formal/informal resources available to the person. The Committee is concerned about the possible inclusion of a "multiracial" category, without an additional element requesting specific racial detail and/or primary racial identification, because of its anticipated impact on trend data and loss of specificity. The National Committee on Vital and Health Statistics (see appendix A for roster) has completed a two-year project requested by the Department of Health and Human Services to review the current state of health-related core data sets; obtain input on their collection and use; interact with data standards-setting groups; and, most importantly, promote consensus by identifying areas of agreement on core health data elements and definitions. 1. Additionally, includes optional data elements to describe the patients living arrangements and marital status. Producing the compendium was a much more involved effort than was originally envisioned, and probably is representative of problems to be overcome in the future when standardization implementation is planned. 7. Commonwealth of Virginia, Department of Medical Assistance Services, William R. Taylor, M.D., M.P.H. Paul L. Grimaldi, Ph.D. University of Iowa. University of Colorado Health Sciences Center, Inpatient Administration, Charles J. Rothwell There may be more than one health care provider identified: A.The health care practitioner professionally responsible for the services, including ambulatory procedures, delivered to the patient (health care practitioner of record) Data sets received were assessed for their consistency with other data sets, particularly minimum data sets such as the UHDDS and the UACDS, the HCFA 1500 and the UB 92 data sets, and also with other current and future data sets under development by data standards organizations (ANSI). Refer the core health data elements recommendations to the National Uniform Claim Committee for their consideration as they study the issue of uniform data elements for paper and electronic collection in Fall 1996. The Committee recommends that the HCFA identifier be adopted when completed. In addition, the Committee and Department have been involved in activities related to standardizing the collection of data in the long-term care setting. In some situations, it is possible that a free-form narrative will be collected in place of the codes, to be coded at a later point. American Association of Retired Persons, Peg Douglas It is recommended that the NPF be the source of all unique provider identifiers, for institutions and individuals. Why such data sets are needed in the current and evolving health care arena; What multiple functions they might accomplish for a variety of different users; What data elements (including definitions, vocabularies and coding structures) they might contain; and. Colorado Hospital Association, Nancy Breen, Ph.D. By January 1998, all California State Department of Health data bases will contain five data items to facilitate linkage. A. Four digits are recommended for the discharge year. The Commonwealth of Massachusetts, Rate Setting Commision, Daniel J. Friedman, Ph.D. Health Care Financial Management Association/ASC X12, Kenneth E. Roos, M.S., M.B.A. Used in the National Health Interview Survey and many other studies, this item has been shown to be predictive of morbidity, mortality, and future health care use, when collected in a general interview type of setting. Institute for Health Policy Studies, UCSP School of Medicine, Christopher G. Chute, M.D., Dr.P.H. One would be through the use of a state-level or regional-level organization that already has a line of communication with other organizations. Collection of years of schooling has been recommended by the NCVHS and others as a proxy for socioeconomic status (SES). University of California. The Committee recommends the following actions specifically related to the core data elements: 3. The UHDDS currently in use was promulgated by the Department in 1985; the NCVHS recommended and circulated a revision in 1992, with additional recommendations from an Interagency Task Force in 1993. 200 Independence Avenue, SW HHS, CDC, NIOS&H - ALOSH, Division of Safety Research, Kris Haltmeyer The Uniform Hospital Discharge Data Set, which is referred to as the 'UHDDS,' is the core data set for inpatient admissions. If a reporting entity is using a different element or definition, explain why their current usage is preferable. The UACDS is a recommended set, not a mandatory one. American Nurses Association, Larry W. Miller Bureau of Vital Records and Health Statistics. The personal/unique identifier is the element that is the most critical element to be collected uniformly. And now, with movement toward HMO's, PPO's, and other types of managed care, there may be a greater need to share identifiable data. 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